This is our only Home. We want to engage society actively and constructively. Only by asking the right questions can we arrive at the correct answers.
There is no need for fear as we are only doing what we must. To be apathetic is to be selfish and derelict in our duty to our children and our children's children!
Huang Shoou Chyuan

Sunday, July 13, 2014

Medishield Life- Singapore's Obamacare... what's there not to like?

A long-time reader of my blog asked me to comment on
Medishield Life (MSL) (MOH link here, here and here) from a doctor’s view-point.

LOL- the assumption was that doctors understand Medishield
more than the lay-person.

Truth be told- many of us, docs, do not fully comprehend the soon to be defunct Medishield as it was irrelevant to us (esply in the private healthcare system).
When asked by many patients how this 2nd of the 3Mie (Medisave/Medishield/Medifund)
was relevant to their impending surgery/hospitalization… I just truthfully say-
“it is irrelevant to you ( in private hospital with elective ENT condition)
as it does not affect you”.

The high “deductibles” plus the “co-insurance” portions
means that when the final invoice is issued- little (if any) Medishield funds
will be disbursed in most private hospital scenarios. Please do not be confused with the Private Integrated Plan ( enhanced private scheme that supplements
Medishield).

Private hospital healthcare is very
expensive and as Medishield is designed for the public hospitals’ B2/C wards in
mind, the payout portion is miniscule compared to the total private hospital
bill and even if disbursed, it will be such a negligible portion of the total
bill as to be meaningless.

Friends- I hope that you do not think me as condescending …
but if you think public healthcare is expensive, you have not seen anything
yet.That is why we must do
something to ensure healthcare remains affordable to Singaporeans … in both public
and private healthcare sectors. Did you know that public hospitals often act as
pricing signal for the private sector? Many procedures/investigations cost more
in the public hospitals. Hard to believe?

Also- don’t confuse MSL with CPF Life or with the debate
about CPF payouts or even with the court case about the PM and Roy.

Medishield Life (MSL): Universal coverage that will be
affordable to most in B2/C Ward setting.

1.MSL is not free healthcare. Anything that is free attracts morale hazard ( also known as buffet syndrome). Co-payment ( even a little) makes one less generous with other people’s money. Hence I am a strong believer in need for deductible and co-insurance.

I have seen people who feel that since they paid insurance
premiums- then their hospital stay should be like a holiday stay with
consultations with multiple different specialists (even when not needed) and with many expensive
tests thrown in for good measure.

All -even those with pre-existing conditions and previously
uninsurable ,are covered. No one is rejected ( although there is higher
premiums for pre-existing conditions). IMHO- it is good that no opting out
means that no one sacrifices his health due to pressure from domestic
situations etc. All of us chipping in to ensure no one gets left behind is a good thing.

Lower co-insurance: That means for each hospitalization- out
of pocket cash portion is less.

Rightly- higher wards such as B1/private wards and private
hospitals, does not come under ambit of MSL. Government should take care of
basic no-frills healthcare. If one wants the bells and whistles- then pay for
it.

3. Cost of future healthcare should be consciously contained

Even in public hospitals- the cost should be contained or
else the payouts from the MSL would soon be made redundant in a few years time.
Eg the surgery cost for Table 7 ( most complex surgery) will easily be more
than $2000 (MSL surgery claim limit now) if not controlled.

4. Perceptions of B2/C wards should be addressed

The general public perception that doctors/medications for
B2/C class are inferior to higher class wards should be addressed and corrected.
Does MOH keep track of every hospital department to ensure that doctors with
appropriate competence treat each patient regardless of ward class? I am sure the majority of departments do- but are there black sheep department? If one
needs robotic or minimally invasive surgery- one must get it (and not have to
upgrade to higher class ward). If Generic (unbranded) drugs are just as good they should be used for
all class patients. Proprietary (branded) drugs still under patent- should be
used in patients of all class- if needed. No discrimination!

Every public hospital is a teaching hospital- regardless of
class ward- trainees (medical students/ post-graduate doctors) should have
access to all patients – but they should of course be closely supervised. Doctors have been trained via apprenticeship from time in memorial!

I fully support the thinking behind MSL. No one should be
left behind. We should tweak the top-ups to help those who have problems paying
for the premiums and keep an eagle eye to ensure every public hospital
department does not neglect B2/C ward patients.

Don’t anyhow protest.. or we risk throwing out the baby with
the bath water.

1 comment:

I don't know why there are so many adverts on TV regarding MSL. They are willing to spend so much money for the advert instead of increasing benefits of MSL.What is the use of no lifetime limit when the you can claim so little? The surgical table limit is so miniscule. $2000 for surgical procedure 7 is a joke. (the range from table 1 to 7 is $200 to $2000). Really?? which hospital will charge you that rate even for subsidised patients? If they think the plan is for class c/b2 then remove the table limits and peg it to 'as charged' for c/b2 patients in govt hosp.To me, the MSL is just an excuse to increase premiums to subsidise those who are not currently insured and which the state is likely to shoulder the burden.The MSL- small bill, you can't claim because of deductible and co-payment. Big bill, very little to claim because of the surgical table limits. They are covered on all sides.And they say it's good? Pleeease

About Me

I am a doctor.
Everyone,even doctors,has a say in how Singapore is run. (But saying is one thing and getting someone to listen is something else).
For the sake of society, someone has to push the boundaries and seek out the OB (Out-of-bound) markers. So why not me (or is it I)?
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